Last week, over eighty students, trainees, new and more experienced GPs from across Scotland and beyond, met at the annual conference of RGPAS. An action-packed programme provided a wide variety of clinical and non-clinical topics, and there were plenty of opportunities to meet and discuss rural practice. Rural GP-ing in Scotland is a simulating place to be!

Scroll to the bottom of the page for more conference photos…

But we had some GPs from further afield too!

Rural GPs from across Scotland came for the conference…

Kicking off the programme, we heard from Dr Helen Brandstorp of the National Centre for Rural Medicine in Tromso, Norway. Helen provided a good backdrop to the fact that “we’re all in this together” – the challenges and delights of rural practice are prevalent in Norway in similar levels to Scotland. The ground is fertile for further collaboration with international confreres and we hope to see ongoing links with our Norwegian counterparts in rural medicine.

The rest of the conference featured a rich variety of clinical and non-clinical topics of relevance to rural practice. We were lucky to have an excellent range of engaging and entertaining speakers. From updates in emergency medicine, to humanitarian and MSF work, to developing rural LGBT-friendly health services, to IT Reprovisioning, to research tips, to rural surgery, to featured student presentations… there was plenty going on, and the conference dinner provided plenty of opportunity to make further connections and allow the conversations to flow, along with a bit of traditional music too.

We were delighted to host a good number of students, trainees and new doctors… in particular there were nineteen heavily-subsidised student places – and they didn’t disappoint in their contributions of innovative ideas throughout the conference.

The conference rounded off on the Saturday with a visit to the Bristow Coastguard helicopter base at Inverness Airport, where Winchman Paramedic Duncan Tripp and his colleagues treated student and experienced GPs to a tour round the facilities, including one of their £26 million Sikorsky search and rescue helicopters.

In the control room, describing what happens on notification of an emergency rescue.

One of the Sikorsky S92s – with lots of impressive kit

Duncan explaining his role as flight crew, winchman and paramedic… lots of important things to consider, hence the bright orange flight suit!

Thanks to all those who presented, and to all others who contributed to the conference planning. The event proved to be fun, engaging and relevant to rural practice. We hope to do the same next year – provisionally booked at the Craigmonie Hotel again on 2nd-4th November 2017. Meantime, at RGPAS we are keen to stimulate and encourage further work in Scottish rural practice. A new committee was formed, and I am delighted to take the helm of an able and enthusiastic team. It’s going to be an exciting year!

Twitter hashtag: #RGPAS16

Once again, we hope to welcome both new and experienced rural health professionals, and we have a stimulating programme lined up to cover a wide spectrum of topics which are relevant to rural general practice in Scotland.

In January this year, I was contacted by Pauline von Zabeltitz, a final year student at the University of Aberdeen, who was studying for an MA (Hons) in Economics and International Relations.

For her dissertation, she was keen to explore the various projects and initiatives being used to improve recruitment and retention to rural GP practice in Scotland.

Pauline has very kindly agreed to having her dissertation published on RuralGP.com in order to share the analysis that she has undertaken over the last six months. Her report provides yet more substance behind some of the core issues that we know affects rural recruitment & retention, whilst providing another perspective and some new ideas to add to the present work on this area.

Coming from a family with a strong medical background, healthcare related issues have always been of great interest to me and throughout my degree, I got the chance to explore this topic further through a Health Economics course. Discussing Health Economic issues and policies led me eventually to my final Dissertation topic, writing about the recruitment and retention issues in rural Scotland regarding healthcare providers such as GPs.

Specific issues highlighted include rural connectivity, access to undergraduate placements and the GP Rural Fellowship scheme. She manages to cover a wide spectrum of other considerations, and some evaluation of present approaches to this problem.

Applications are now being invited for the second round of the GP Rural Fellowship Scheme, overseen by NHS Education for Scotland.

The Fellowships offer a fantastic opportunity to build skills and experience in rural general practice, whilst experiencing the challenges and opportunities first-hand – during a well-supported year which includes nine weeks of study leave and a generous study budget.

The Fellowships are located across rural Scotland, from Dumfries & Galloway, to the Shetland Isles, including islands such as Islay, Arran, Skye and the Uists.

Interviews will be held in Inverness on Friday 3rd June. Fellowships (one year) commence in August 2016.

Why be a rural GP?

In January last year, the BBC Countryfile team visited Arran to see for themselves…

… and NHS Highland recently made this video of rural practice in Kintyre…

… and here’s a video just released (March 2016) featuring some of the current Fellows and others involved with the scheme…

Interested? We want to hear from you…

All the Rural Fellowship sites will welcome you to chat on the phone or visit and tour round what’s on offer. We can fix up a chat with current or previous rural fellows, and you can ask questions on our Facebook page. There is a lot of information available from the websites mentioned already, but sometimes it’s easier to arrange a chat on the phone or Skype… all descriptors of the Fellowships (on the official fellowships page) have contact details where you can find out more.

Last year we interviewed some of those involved in running the Rural Fellowships. Hear more from them about what they think the fellowships can offer recently qualified GPs…

Gill Clarke – Fellowships Co-ordinator

Gill has been running the fellowship scheme now for three years. I asked her about the opportunities available, and why she thinks the fellowship scheme is a good way to enable recently-qualified GPs to experience rural practice.

Angus MacTaggart – Islay Rural GP

Angus is one of two principals of Islay Medical Services, which now delivers primary health care across the island, as well as out of hours and hospital services. He describes the attractions and challenges that he identifies with rural practice.

Jonathan has trained in a multitude of specialties, and has found his ‘perfect’ job requiring constant generalism. He represents the growing number of ‘acute rural GPs’ who provide hospital-based services as well as out-of-hours GP cover. With additional strings to his bow such as anaesthetics, the services provided in Broadford mean that patients can frequently be treated locally, instead of facing long journeys to secondary care.

Fiona oversees GP services to the North of Scotland, which covers a wide geographical area. Two fellowships are available in this area. In this interview, Fiona highlights why a move to Sutherland could be a great career move to aspiring rural GPs.

Apologies for the phone interference in this interview, hopefully it is not too distracting! You can email Fiona at: fiona.duff@nhs.net

David Hogg – Arran Rural GP

David oversees the Arran Rural GP Fellowships along with Dr Greg Hamill. Over half the Arran GP team have been Fellows in the past, and the Arran GP Fellowship offers a great mix of core GP, OOH and community hospital work. Arran is the highest rated island destination in Scotland by TripAdvisor (4th in the UK) and has a great mix of outdoor activities and culture.

Applications are now being invited for the GP Rural Fellowship Scheme, overseen by NHS Education for Scotland.

The Fellowships offer a fantastic opportunity to build skills and experience in rural general practice, whilst experiencing the challenges and opportunities first-hand – during a well-supported year which includes nine weeks of study leave and a generous study budget.

The Fellowships are located across rural Scotland, from Dumfries & Galloway, to the Shetland Isles, including islands such as Islay, Arran, Skye and the Uists.

Why be a rural GP?

In January last year, the BBC Countryfile team visited Arran to see for themselves…

… and NHS Highland recently made this video of rural practice in Kintyre…

… and here’s a video just released (March 2016) featuring some of the current Fellows and others involved with the scheme…

Interested? We want to hear from you…

All the Rural Fellowship sites will welcome you to chat on the phone or visit and tour round what’s on offer. We can fix up a chat with current or previous rural fellows, and you can ask questions on our Facebook page. There is a lot of information available from the websites mentioned already, but sometimes it’s easier to arrange a chat on the phone or Skype… all descriptors of the Fellowships (on the official fellowships page) have contact details where you can find out more.

Last year we interviewed some of those involved in running the Rural Fellowships. Hear more from them about what they think the fellowships can offer recently qualified GPs…

Gill Clarke – Fellowships Co-ordinator

Gill has been running the fellowship scheme now for three years. I asked her about the opportunities available, and why she thinks the fellowship scheme is a good way to enable recently-qualified GPs to experience rural practice.

Angus MacTaggart – Islay Rural GP

Angus is one of two principals of Islay Medical Services, which now delivers primary health care across the island, as well as out of hours and hospital services. He describes the attractions and challenges that he identifies with rural practice.

Jonathan has trained in a multitude of specialties, and has found his ‘perfect’ job requiring constant generalism. He represents the growing number of ‘acute rural GPs’ who provide hospital-based services as well as out-of-hours GP cover. With additional strings to his bow such as anaesthetics, the services provided in Broadford mean that patients can frequently be treated locally, instead of facing long journeys to secondary care.

Fiona oversees GP services to the North of Scotland, which covers a wide geographical area. Two fellowships are available in this area. In this interview, Fiona highlights why a move to Sutherland could be a great career move to aspiring rural GPs.

Apologies for the phone interference in this interview, hopefully it is not too distracting! You can email Fiona at: fiona.duff@nhs.net

David Hogg – Arran Rural GP

David oversees the Arran Rural GP Fellowships along with Dr Greg Hamill. Over half the Arran GP team have been Fellows in the past, and the Arran GP Fellowship offers a great mix of core GP, OOH and community hospital work. Arran is the highest rated island destination in Scotland by TripAdvisor (4th in the UK) and has a great mix of outdoor activities and culture.

R&R Fellowship Advert goes out mid March

Are you looking for a new challenge or looking for a rural job and want to have more experience or supported learning before you take the plunge? If so then the NES Remote and Rural GP Fellowship might be the answer.

The fellowships will be advertised on the NES website in mid March and offer R&R placements both in General Practice (standard fellowships) and small hospital settings (acute fellowships). The fellowship opportunities vary enormously and include island settings such as Arran and Skye and placements nearer major towns such as Aberfeldy and Cowal, Bute and Stranraer. The placements are for 1 year starting in August. There are sometimes opportunities to start them later in the year so don’t let finishing ST3 late put you off applying.

There is a generous educational allowance in terms of a budget for training and there is also a 2- 3 month leave opportunity meaning you can get on with doing some of the more difficult and time consuming learning you might want to do. Previous fellows have done coil training, dermatology diplomas, minor surgery training and Anaesthetic, Paediatric and Palliative care placements.

3 Fellowship courses are provided a year and we organise these in rural settings generally including an island setting and somewhere near the mountains. We cover a mixture of topics on the courses such as emergency obstetrics, ENT and Ophthalmology for remote doctors, mountain medicine and retrieval and then we also look at the humanities in medicine with a rural bias. The fellows are encouraged to take an organisational role in courses and often proffer their experience for training themselves. Last year Andrea did a wonderful session on Mindfulness and Yoga for beginners. This year Sarah is doing a session on Palliative care practical skills. The aim of the courses is to provide a fun and inclusive training experience encouraging the fellows to develop networking opportunities.

Peter and Cat try doing Paeds training in castle grounds

Jenny and Zoe package a child just off the beach at Onich

Andrea teaches Mindfulness in Islay

Holly teaching about the advantages of European medical exchanges at the Orkney course with newborn baby

If you are interested in the scheme phone Gill Clarke the scheme co-ordinator on 01463 233 823 for further information. Go on take the plunge and do something different. It’s only for a year and it might change your life!

Photos by Gillian Clarke

Last month I had a visit from three second-year medical students from Glasgow: Lara, Zeyar and Faseeha. They were keen to get some footage for a video to give fellow students an insight into the challenges and attractions of a career in rural practice.

Dr Gill Clarke, co-ordinator of the GP Rural Fellowships in Scotland, has filed this report from the Fellows’ recent meet up at Onich (near Fort William)…

Working together in a paediatric trauma case

We have just had the first Rural Fellowship course of the year in Onich. Introductions were slightly disjointed as fellows were arriving from as far away as Arran, Orkney and Islay and true to form the A82 was blocked at Drum necessitating a trip around the South side of Loch Ness for the new Orkney fellow. He seemed to take it in his stride.

A recurrent theme for training for the fellows is paediatric resuscitation skills and so we started the course with just that. Fellows were encouraged to bring their Sandpiper bags along and they were clearly nervous as the drills started in earnest. As usual when presenting in a hotel environment there are things that are a challenge for everyone. Several hotel staff and visitors popped in to shouts of “help, help” and the stags head picture on the wall needed to be moved for the power point presentation.

The following day the ambulance crews from Lochaber were invited to join in the training scenarios and also advise on difficult extrications. The day was beautiful as the pictures show and allowed for plenty of discussion on retrieval policies across Scotland and working together as a team in difficult situations. Pam Hardy (consultant in A&E Dr Grays) and Alison Macleod (ex consultant A&E Basildon and now GP training in Highland ) led the training and both commented on the enthusiasm and skills of the fellows.

There are 6 fellows this year with a new fellowship in Islay. 2 of the fellows hail from Ireland and 2 are from Wales. The fellowship scheme is co-ordinated by Gill Clarke and she is happy to field calls if you want to know more about it ( gillian.clarke1@nhs.net )

The programme includes a keynote speech from Dr John Wynn-Jones, Chair of the WONCA Working Party on Rural Practice. He will speak about “Expanding Rural Horizons – What Benefits of International Collaboration?”.

Other speakers on Thursday (registration at 0930h) include:

Dr Penny Lockwood, with exciting plans to offer an intercalated degree in Rural Health at Dundee University

Dr Kim Miller from Aberdeen University will provide an update about undergraduate training

Dr David Cunningham from NES will speak about “Rural CPD and NES – What Can We Offer You?”

Dr Andrew Buist will provide an update from the BMA about the proposed 2017 Scottish GP Contract

Dr David Binnie, GP from Colonsay will present an audit on Emergency Activity on the island

Dr Helen Robinson will speak about the ‘Singlehanded’ Project

Dr Chris Williams will inspire, inform and enthuse us all to realise the benefits of social media!

… followed by an informal dinner at Sam’s Indian Cuisine.

Friday’s line up (starting at 0900h) includes:

Mr Steven Ross from Raigmore Hospital, with a pragmatic update on ENT presentations

Dr Hamish Greig will discuss the opportunities and considerations of using ultrasound in rural general practice

Dr Drew Inglis of the EMRS Team will tell us about the latest efforts to improve connectivity in rural Scotland

After lunch, Dr David Hogg will lead a session aimed at students and trainees – but open to all – on ‘Rural Practice and Me’. Watch this space! This will be followed by the RGPAS AGM – again open to all, and which often involves lively and informative debate.

… a conference dinner will then be held in the hotel.

On Saturday we are welcoming a visit from the EMRS squad, who will provide a number of practical work stations to brush up on emergency care skills.

Today I am attending RCGP Scottish Council in Edinburgh. As part of this, I was asked to report on my experience in attending the WONCA World Rural Health Conference in Dubrovnik – on 14-18 April 2015. I thought it might be helpful to share this report here.

WONCA Rural Conference, Dubrovnik – 14-18 April 2015

Report to RCGP Scottish Council

In April 2015 I attended the WONCA World Rural Health conference, held in Dubrovnik. Five months on, it is helpful to reflect back on the experience of attending WONCA Rural, and what I have acted upon since my return from Croatia.

Firstly, I would like to thank RCGP Scotland for financial support to attend the conference. Such support is effective and appreciated to help release GPs like myself from practice commitments. It is clear that Scotland has much to share about developing and innovating rural general practice, as well as being able to learn from approaches taken by our international conferères too.

I am also grateful for support from Drs Miles Mack, John Gillies and the RCGP Scotland team in preparing material for the conference.

WONCA Rural 2015 brought together rural practitioners from across the world. Historically there has been a higher proportion from the UK, Eastern Europe, Canada, USA, Australia and New Zealand. However it is clear that there is growing membership from African and Asian countries, and indeed there are intentions to hold the next WONCA Rural Conference in Africa.

There were many lessons, benefits and conversations during the 4 day conference. As usual, informal discussion amongst confrères opened up more learning than the conference presentations: and there was plenty of inspiration and quality research/innovation being presented in these sessions. Whilst in Dubrovnik, I posted a number of podcast interviews to this website.

There were a number of core themes that I took away from WONCA Rural…

International similarities

Rural practitioners are united by similar challenges and attractions of rural practice. There are often frustrated levels of bureaucracy as a result of providing a wide spectrum of care across traditional domains of healthcare. From connectivity and immediate care provision, to blurred funding streams between primary care and community hospital work, and a constant difficulty in navigating the politic that goes with negotiations; it was reassuring to listen to more experienced GPs from other countries who have the same issues that we have in Scotland. Younger rural GPs all express a frustration with the need to ‘learn politic’ and persuasion skills in order to achieve even basic improvements in clinical care. This is made particularly challenging as management training is lacking from most GP training programmes.

Recruitment and retention challenges exist internationally, and there are common approaches to this. The role of mentorship models is increasing, along with recognition that ‘single handed practice’ is declining in popularity and sustainability – and are being replaced by federated, group or other networked practice models. There was interest in the GP Rural Fellowship programme in Scotland, which has helped to introduce recently-qualified GPs into rural posts. However the challenge of filling posts remains ever-present and similar across the world.

It is widely accepted that harnessing the interest and enthusiasm of medical students in rural practice, can be a powerful means by which the attractions (and realistic perspective) of rural practice can be highlighted. Action is needed to ensure that funding is increased to facilitate greater involvement of undergraduate training opportunities in rural practice; similarly support to trainees in rural practice needs to be protected and expanded. The John Flynn programme – run by the Australian College of Remote & Rural Medicine (ACRRM) is a great example of what can be achieved by supported training opportunities in rural practice. Pragmatic support of undergraduates and trainees is vital: appropriately funded accommodation, travel and consideration of the impact on spouses/partners and family.

That said, we are not alone in having to navigate the constraints of geographically-defined training schemes, although there is work especially in Canada and the USA to provide rural-track training programmes, similar to the ones now in place in Scotland.

Social Media

There are numerous networks to join, and participation in these international approaches is important to develop further within Scotland. Social media is an easy way of reducing professional isolation, and there were several workshops looking at how to encourage others to join the conversations, and improve fluency in its use. Throughout the conference, the twitter hashtag #woncarural2015 was used and a search for this now will reveal the active conversations taking place at the time.

I use Twitter regularly to keep an eye on recent trends/new guidelines etc. It was great to meet some of the faces behind these twitter profiles!

@davidrhogg @IVLINE @ruralgreengp @ruralflyingdoc and Leslie Rourke

Identity

Rural practice needs to improve its collective identity. It was apparent that those countries with a thriving network of rural GPs had a stronger buzz about rural GP opportunities – as well as highlighting generic benefits of general practice. The ACRRM is perhaps a model that we need to reconsider in Scotland – by building up and consolidating what we already have. The current setup of relatively un-linked institutions, from RCGP, Rural GP Association of Scotland, School for Rural Health & Wellbeing, NES, RRHEAL, Centre for Rural Health and the RCGP Rural Forum serves to dilute the collective identity, duplicate certain efforts, and I think something needs to be done to pull these organisations tighter together with a more collaborative strategy.

In November 2014 the Rural GP Association of Scotland (RGPAS) became the new name for the Remote Practitioners’s Association of Scotland (RPAS) and we have been building specifically on work to support practising rural GPs, as well as undergraduates in rural practice. We’ve also improved social media and online presence.

There remains a wider need to realise the potential synergies that could be realised by organisations working better together.

Use of existing mechanisms

One particularly interesting conversation with an experienced GP in Australia, led to learning about the set up of a ‘Managed Educational Network’ – and how such established routes of networking can be harnessed to achieve wider goals. He advised on the importance of identifying existing organisations and their objectives, in galvanising resource to make projects happen.

On my return, I met with RRHEAL and NES, and highlighted the obligations from RRHEAL’s mission objective to facilitate managed networks in rural practice. This has resulted in a PDSA to assess whether a Scotland-wide MCN (clinical network) or MEN (educational network) could help to link up Scotland’s rural GPs by VC on a semi-regular basis.

Innovation in rural health care

There were some great examples of where rural practice is leading new approaches in training, clinical skills development and other aspects of clinical care. Some of these are similar again to current work in Scotland. The increasing role of simulation training particularly for high intensity low frequency clinical scenarios was evident from several speakers.

Lessons from conference workshops have already been put into action on Arran where we have been developing the use of simulation training.

The increasing role of ultrasound in clinical practice was also raised frequently. Given that this is a safe, potentially transmissible and higher acuity diagnostic near-patient test, we are likely to see its use in rural practice develop considerably.

The role of the rural GP in providing leadership and advocacy in more generic challenges of rural living was apparent. Whether representing rural healthcare on a political level, engaging in media work or leading projects such as improvements in connectivity – all these aspects of professional life were common.

Presentation of ‘RCGP Scotland Being Rural’

I presented the RCGP Scotland paper to an audience of approximately 50-60 on the Saturday morning of the conference. This was well received, and the twitter conversation continued well past the conference conclusion too. The wider perspective provided by Miles Mack’s mind map of challenges to rural practice, was appreciated and recognised by colleagues across the globe. In particular, the constraints resulting from infrastructure difficulties in rural areas was a common theme.

Here’s a summary video of the main points of the Being Rural paper.

Summary

Attendance at WONCA Rural allowed an important Scottish input to the debates and conversations about international rural health. It was an opportunity to obtain a wider perspective on how others are dealing with common challenges including recruitment, retention, burnout, effective training of the ‘next generation’ and representation of the generalist approach amongst an increasingly specialist medical world. I hope that Dr John MacLeod, Lochmaddy GP and one of the founding members of WONCA Rural, would have been proud of the ongoing Scottish participation from those of us who made it to Dubrovnik. Personally, it helped to open many doors for future collaborative working, particularly with confrères in Australia, New Zealand and Canada.

Next actions

There have already been outcomes from participating at Rural WONCA. The priority now is to share the momentum that exists amongst WONCA partners to inform, enthuse and stimulate better representation, and an effective collective identity, amongst rural GPs in Scotland. RCGP Scotland has a pivotal role in supporting both existing and prospective members and I hope that it will be possible to translate this effectively into useful actions via the RCGP Scotland Rural Strategy Group.

David Hogg, September 2015

Now want a different perspective? See these other reports from Dubrovnik 2015.